POSTURAL CONTROL Flashcards
All mobility tasks share in common what 3 essential task requirements
- Progression = motion in a desired direction
- Stability = postural control
- Adaptation = ability to adapt to a changing task and environmental conditions
The neural regulation of tone contributes to anticipatory and reactive postural control based on what
previous experiences and learning
What leads to the activation of postural muscles in mobility
Support given during the task and the initial posture
Preparedness for the task results in….
a shortening of the onset time for both postural and prime mover muscles
Can mental imagery help prime the system
yes.. q
From what systems does CNS gain important information about postural control and balance
- Vision
- Somatosensory
- Vestibular
- CNS integrate this and initiates goal-directed conscious actions and automatic unconscious adjustments to posture and movement
What input dominates on a firm surface
somatosensory
On an unstable surface what system inputs the most
vestibular
What is Limits of Stability
Max distance an individual is able or willing to lean in any direction without loss of balance or changing BOS
What influences limits of stabiilty
Height, foot length for A/P direction, as well as COM position and movement
What is postural sway
Postural shifts to maintain balance
What Postural sway strategy is used for small perturbations on firm surfaces
ankle
What postural sway strategy is used with large perturbations or if support surface is narrow and smaller than feet
hip strategy
When is stepping strategy used
when a postural perturbation is strong enough to displace the COM out the BOS of the feet -forced to take step to bring COM into BOS
What occurs to sway in elderly
Sway is increased during quiet stance in the ant/post and med/lat position
What are the reactive control alterations in elderly
- Slower onset time post perturbation
- Increased co-activation (co-contraction)
- Tend to use hip strategy more than young adults
Explanation for altered reactive control in the elderly?
- Delay in central processing time
- Slower nerve conduction in afferent/efferent pathways
- Muscle weakness (ankle>hip)
- Decreased muscle ROM
Changes in postural control post stroke
- Increased sway in standing
- Typically presents with hesitancy to shift weight towards weak side
- Delayed postural responses with perturbation
- Loss of postural muscle activation during voluntary movements
- Inability to adjust to changing task demands
Are stroke patients aware of their deficits in balance?
yes normally
What is pusher syndrome
When person with one sided damage to brain pushes self over to weaker side due to perceptual deficits/alignment deficits
Is incidence of falls higher among PD patients
yes - more than 1/3 of patients with PD experience fall s
What are observed postural changes in individuals with PD
- increased medial lateral postural sway in quiet standing
- Altered anticipatory control
- Altered reactive control (particularly in LE perturbations)
assessment tools/outcome measures for postural control/balance
- berg balance scale
- Community balance and mobility scale
- Functional reach test
- TUG
- BESTest and Mini BESTest
- Dynamic Gait index
- Function is sitting test
What does BEST stand for in BESTest
Balance evaluations systems test
7 domains of balance in the BESTest
- Biomechanical constraints
- Stability limits/ verticality
- Anticipatory
- Postural responses
- Sensory orientation
- Stability in gait
What is the Goal of the BESTest
to diagnose which balance system is affected and develop Rx plans to intervene on the balance system
Does training one balance domain help with the other domains
no
What are the domains on the mini BESTest
- Anticipatory
- Postural responses
- Sensory orientation
- stability in gait
What are some contributory factors to fall
- Smaller limits of stability
- with age + neurological injuries you may get abnormal representations of limits of stability, leading to postural instability
- The use of stepping/leaning strategies more than ankle strategy which is correlated with increase risk of falls
What is the goal for treatment for postural control
To increase trunk activation/motor control/client’s ability to maintain upright
